The physical improvement was marked in nearly all the cases operated upon. The results however do not justify the statements which have occasionally been made as to the influence of bodily disorders, especially of the female generative organs, in the production of insanity. Surgery has done much for the physical comfort of the majority, benefited the mental condition of a few, and rarely has materially aided a perfect restoration both mentally and physically.

In conclusion let me say that the insane, from a surgical standpoint, have the same right as the sane, no more, no less.

W. J. Mayo, M. D., City,

Rochester State Hospital, Rochester, Minn.

Dear Doctor: Pursuant to your request for a report as to the results of operations among the insane I herewith submit for your consideration a report of one hundred cases, operated upon by you, which is obtained form our records and from the report of Superintendent H. A. Tomlinson of the State Hospital, St. Peter, Minnesota.

These cases are selected at random and include both the acute and the chronic insane.

The total number reported as mentally improved is sixteen; nine of these are acute insane, seven chronic insane cases. Eight manifested a mental improvement which can be directly attributed to the operation; these are given below, the remaining

were only indirectly improved or the mental improvement was coincident with the operation.

Case, acute melancholia, uterus retroverted, enlarged and adherent showed a decided mental improvement after operation. Case, chronic melancholia, uterine fibroid, cystic degeneration of Fallopian tubes and ovaries. Mental improvement after operation.

Case, circular insanity, laceration of cervix and perineum, somewhat improved mentally after operation.

Case, acute melancholia, prolapse of rectum. Improved mentally after operation.

Case, acute melancholia, retroflexion, lacerated perineum and cervix. Mentally improved after operation.

Case, acute melancholia, double inguinal hernia, showed slight improvement after operation.

Case, chronic melancholia, double inguinal hernia, slight improvement after operation.

Case, chronic delusional insanity, depression in the right superior frontal region, partial mental recovery several months after operation.

The number of cases mentally improved is not as large as we would like to see following this operative work, but the marked physical improvement and the relief these patients receive is sufficient to commend all cases suffering from physical ailments to be relieved when possible by surgical measures.

Fraternally yours,

ERNEST Z. WANOUS.

DISCUSSION.

DR. W. M. EDWARDS: I will refer briefly to the Michigan Asylum. In 1897 we had an appropriation for a hospital for acute cases among women and in 1898 we opened it. We have had now, in almost three years, about three hundred cases and have done more than fifty operations. We have now a woman recovering from a laparotomy, another recovering from an operation for the repair of the outlet and a laceration of the uterus, and another recovering from an enucleation of the eye. We do these things not to cure insanity but to relieve the patient. We have a large number of cases among the women patients receiving what is ordinarily known as local treatment, some twenty-five or thirty per cent. I do not think that we are different from other institutions and I only state this to reiterate that the officers and superintendents of asylums are really doing something to relieve their acute

cases.

DR. RICHARD DEWEY: The paper read by Dr. Mayo presents in the most able and conservative manner the conclusions which any man will arrive at who candidly studies the matter. Though few could present them in so clear and cogent a manner. There has often been an exaggerated claim of benefit from operations, the patients being reported as wonderfully relieved or cured at the time, while longer observation showed that no material change had been effected by operations for traumatic insanity or epilepsy or by operations upon the generative organs in the female cases. A principle brought out by Dr. Mayo is that the insane are entitled to as much surgical benefit as the sane population, and the only modification is the necessary modification due to the mental condition. Sometimes insanity prevents things being done for the insane that may be done for the sane. The surgery may be regarded as the same in both conditions, except where the mental state renders measures inexpedient. There are not going to be any revolutionary experiences in securing some surgical cure for insanity, but some cases will be benefited and a few will be cured. The paper by Dr. Mayo was given by invitation; it was due to the discussion I had with the Doctor last year, at the time of the meeting of the Americen Medical Association, and he kindly consented then, at my request, to give us a paper on the subject. I feel that my own personal thanks are due to him and I know a similar feeling will be shared by all our members.

DR. E. N. BRUSH: I cannot resist the temptation to say how thoroughly the temperate and conservative views of Dr. Mayo meet my approval. He speaks with the authority of one who has had ample experience and not from the standpoint of a theorist.

A few years ago our gynæcological friends were telling us that the pelvic viscera were responsible for insanity, but few of them say anything about it now. We all, I think, agree with what Dr. Mayo very concisely says, that the patient is entitled to the best relief that can be afforded, not for the cure of the mental condition, but for the relief of the bodily condition. If it relieves the mental condition well and good, but the experience of Dr. Mayo shows that the anticipations of those who expect much from surgical interference in insanity are doomed to disappointment.

DR. H. B. HOWARD: I was not surprised to hear of that case of chronic appendicitis. I should not be surprised if that was the irritating cause of insanity. I have seen such a case.

DR. MAYO: I wish merely to thank the Association very kindly for their reception of my paper.

On motion of Dr. Woodson a vote of thanks was tendered Dr. Mayo for his most excellent paper.

PROPHYLAXIS OF DEGENERACY AMONG

RECIDIVISTS.

By Dr. Jules Morel,

Superintendent State Asylum, Mons, Belgium.

Criminal anthropology has made rapid progress in Europe since the organization of these congresses.* The Congresses held at Brussels and Geneva were especially fruitful of good suggestions for the care of incorrigibles and recidivists. Jurists have taken up the medico-psychological study of the criminal seriously and the most renowned psychiaters are devoting attention to this in their discussions. Interest in the subject has so much increased since the Geneva congress that special reports have been presented on subjects connected with this branch of anthropology by such eminent jurists as Dimitri Drill, Alimena, Thiry, Van Hamel, Von Lilienthal and Maus, nearly all of them professors of law in European universities. These reports were of as much importance as if prepared by alienists. All without exception recognize that there are among criminals, especially recidivists, a certain number of degenerates, of alcoholics, of mentally infirm, and of unstable equilibrium in which the mental state must be taken into consideration, that the condition of the recidivist is frequently pathologic and that he should not be subject to penal law. Maus, as the result of profound study of the subject, suggests that in every case where there are apparent signs of insanity, the prisoner be examined by a medical expert. Indeed he questions whether the judges, before pronouncing sentence, consider sufficiently the possibility of the existence of epilepsy, of moral insanity, the absence or inversion of

* Addressed to the Congress of Criminal Anthropology held in Amsterdam in September, 1901, for which the original of this paper was prepared.